The Blog

What caregivers need to know about open enrollment

Maybe you have seen the commercials on TV or received a phone call about Medicare Open Enrollment deadlines. As a caregiver of an aging parent do you know what are these deadlines are and what you need to do? It is important to separate the hype of the sales pitch from the actual deadlines and decisions. Whether you are concerned for yourself or for your family member this is the time to take advantage of this open enrollment period to make any changes to current health insurance coverage. Having the right medical coverage in place can ensure that the cost of your loved one’s medical care will be covered and ease some of the financial burden of being a caregiver.

Two things to consider

First this only applies to two groups of people 1) those who receive their health insurance under the Affordable Care Act through the Health Insurance Marketplace and 2) those who want to add a supplement to their current Medicare coverage. Each is a very different program and each has its own deadline. These deadlines DO NOT APPLY to anyone who is covered by an employer plan or if your additional insurance is through a retirement plan. check with your employer or plan manager for your open enrollment dates.

Second, it is important to learn about options and the deadlines before you talk to a particular insurance company. Visit the official government websites first to get helpful and unbiased information about the different plans available. (I’ve provided the links to these official sites below)

Also, Medicare and The Health Insurance Marketplace have “assistors”. These trained individuals do not represent any particular insurance company and provide in-person advice and assistance to help you make the right choice. You can find an assistor in your area by using the website links.

When you know what kind of coverage you want and need you will be better prepared to talk to a particular insurance agent or company to see if the plan they offer meets your needs.

Two Groups

Group One – Health Insurance Marketplace

If you do not have Medicare and you are receiving health insurance coverage under the Affordable Care Act through the Health Insurance Marketplace you actually have several deadlines to consider. If you want to add or make changes to your current insurance you need to do so by the December 15th for coverage changes to take effect on January 1st. There are then two additional deadlines by January 15th for an effective date of February 1st and January 31st effective date of March 1st. If you do not choose or make changes by January 31st you cannot enroll or make changes until next year’s open enrollment period. There are exceptions but the place to learn more is at www.healthcare.gov. Here you can learn about all of your options, the plans and their costs and to see if you qualify for any savings or rebates.

Group Two – Medicare

There is no annual open enrollment for Medicare. Once you are receiving Medicare it never needs to be renewed. Each year Medicare will make changes to its plan, what it covers, the annual deductible and other benefits, but there is nothing a Medicare recipient needs to do or can do to change these benefits.

Medicare Part B only pays 80% of the cost of the care and only after you have paid the annual out of pocket deductible ($134 for 2017). So many individuals will purchase additional or supplemental insurance through a private insurance company to cover these costs. Medicare does not cover prescription drugs, vision or dental costs. Anyone wanting this insurance must purchase additional coverage through a private insurance company. The deadline to make these changes or additions is December 7th for coverage to be effective on January 1st. This Annual Open Enrollment period of October 15th – December 7th is the only time you can add or change these additional insurance plans.

Two kinds of Additional Medicare Plans

Before purchasing additional insurance, you should thoroughly understand the difference between the two types of additional Medicare Plans offered. Both types must adhere to Medicare policies and guidelines. Visit the official Medicare website at www.medicare.gov. to learn more about what is covered and the plan options.

Secondary or Supplemental Plans

These are plans that are in addition to Medicare. Your medical provider will first send the claim to Medicare who will pay the provider 80% of the approved amount. Then either Medicare or the provider will send the claim to the Secondary Insurance who will then make payment based on the type of plan purchased – usually the remaining 20%. These plans usually have higher monthly premiums, but little or no co pay and may cover the annual deductible. These plans may also include coverage for prescription drugs, vision and dental. But this is where you need to do your research and shop around for the best plan to meet your needs.

Advantage Plans

These plans replace Medicare – well sort of – but not quite. You still have Medicare coverage but the insurance company handles all of the claims and payments to the medical providers. A provider will send the claim directly to the insurance company and not Medicare. The insurance company will pay the claim based on your particular plan’s policy – not necessarily what Medicare would pay. Medicare then reimburses the insurance company, at the Medicare rate. These Advantage Plans are usually all-encompassing, covering prescriptions, vision and dental. Some have very low monthly premiums but higher co pays and out of pocket expenses. So it is very important to know what you need and for those on a fixed income how much you can afford to pay out of pocket. Compare these to the supplemental plans so you can be sure you know you are paying for the coverage you need.

Summary

So as a caregiver you need to be sure your loved one has the necessary medical coverage to meet their needs at a cost they can afford. Now is the time to do the research and make the necessary changes to be sure they are covered for 2018.

** This is a repost of a blog I wrote in 2015. The basic information remains the same and I made revisions to reflect the current dates and dollar amounts. However please refer to the official government websites for the most up to date and accurate information. **

I hope you found this helpful. Please be sure to send me your comments and questions.